PMD demo: 'We have begun'

Friday, September 28, 2012

WASHINGTON – CMS officials didn't have much new to share during the Sept. 26 Open Door Forum on the PMD demonstration project, but industry stakeholders had more than a few questions.

CMS’s only real update: "We have begun," said Melanie Combs Dyer, deputy director of CMS's Provider Compliance Group. "We are beginning to receive prior authorization requests at the DME MACs and we're very excited that we have gotten to this point."

As part of the three-year demo, providers in seven states began to submit prior authorization requests for PMDs on Sept. 1.

Among those who asked questions during the forum: Peter Rankin, manager of government affairs for AAHomecare, who asked if there could be a way to expedite the resubmission process if a prior authorization is denied because of a CMS error. For example, should a provider have to wait the required 20 days to get back the results from a resubmission when CMS denied it due to a lack of date stamp that was there?

Combs-Dyer said she would try to add language to the operational guide to address that.

Another listener asked why a Medicare contractor was notifying physicians of the results of prior authorizations via fax, when physicians and providers should be notified at the same time by mail?

CMS officials asked the listener to email them information about the specific cases so they could look into and resolve the issue.

Also during the forum, CMS officials addressed changes to appendices F and G of the operational guide, which states that records can only be changed to show parts of an exam the physician forgot to document, and that supplier generated statements and records are not considered part of the medical record, even if the doctor signs off on them.

View the operational guide at